If a woman rarely or never has sex with men, should she still get regular Pap smears? Absolutely, say experts in lesbian health. Yet a recent study conducted by researchers at the University of Washington on the health of lesbians shows that lesbians are not getting as many Pap smears as their hetero sisters. Since Pap smears are the most effective method of screening for pre-cancerous changes in the cervix, some lesbians may be missing a key opportunity for early detection and treatment of cervical cancer, which, according to the National Cancer Institute, kills 4,100 women in the U.S. each year.
So why are lesbians less likely to receive this vital test? According to experts, the reasons vary. But hetero-centric or misinformed doctors are at least partly to blame. Many doctors are apparently failing to recommend Pap smears to women who identify themselves as lesbians because they believe that women who have sex with women will not contract the human papilloma virus (HPV). HPV, commonly known as the virus responsible for genital warts, has some strains which have now been strongly linked to cervical cancer. Since the Pap smear screens for abnormalities caused by HPV, these doctors do not believe lesbians need them.
But doctors who think HPV is an exclusively heterosexual STD are out of step with the current research. Dr. Jeanne Marrazzo, Assistant Professor of Medicine (Infectious Diseases) and lead researcher in the University of Washington study, states, "Our data, and that of other investigators, show clearly that both cancer-causing HPV types and pre-cancerous changes at the cervix occur in these women, both in the absence of sex with men and many years after last sex with men." According to Dr. Marrazzo's website, www.lesbianstd.com, HPV can be passed woman to woman through genital-to-genital contact, through contaminated fingers, and possibly through inadequately cleaned toys.
One reason doctors may be slow in acknowledging the potential danger to lesbians is that the published guidelines use language suggestive of a heterosexual context. Guidelines such as those promulgated by the U.S. Preventative Task Force, for example, refer to "sexual activity" or, in the case of the National Cancer Institute, "sexual intercourse" as markers for the timing of Pap smears (which should begin three years after such activity). Neither defines their terms or the gender of participants.
"I do think that using the term 'sexual intercourse' in the strictest sense (as it's typically used) discounts the not-remote possibility that women can acquire HPV sexually from other women," Dr. Marrazzo says. "I was somewhat disappointed in the language -- though not surprised, since these groups have been slow to focus on the existence, let alone the specific needs, of lesbians, who are just assumed not to have sex, for the most part."
Although many guidelines follow a heterosexual model, the U.S. Department of Health and Human Services' National Women's Health Information Center is one of the few official sources that specifically advises lesbians to obtain regular Pap smears due to the possibility of HPV transmission.
Ellen Kahn of Whitman-Walker Clinic's Lesbian Services Program has found that many lesbians are neglecting to get their Pap smears for reasons including past negative experiences with health care providers, the erroneous belief by practitioners that women's health care relates only to birth control and reproductive issues, and that many lesbians simply do not know of a health care provider specializing in lesbian health issues.
Kahn encourages all lesbians to obtain not only regular Pap smears but also full pelvic exams which can reveal other medical conditions requiring treatment. Kahn says Whitman-Walker's health programs are particularly sensitive to lesbians who may have experienced past problems with practitioners once their sexual orientation was revealed. She also emphasizes that the clinic provides not only full gynecologic services to lesbians, but also individual time with practitioners they may not find in HMO-oriented practices.
So what steps should women take to protect their health? In general, women should begin getting Pap smears three years after they have their first sexual encounter with a man or a woman, but no later than 21 years of age. The three-year delay allows time for the HPV virus to cause abnormal cells to emerge. Women should get a Pap smear every two to three years until age 65 where the screening may cease if there have been no abnormalities in the pervious ten years -- but even so, this decision must be made in consultation with a doctor.
Pap smears are conducted during a routine office visit, usually in conjunction with a full pelvic exam. The practitioner will dilate the vagina with a speculum and quickly collect some cells from the cervix. Most women find the procedure quick and painless. After the cells are collected, they are placed onto a slide which is then sent to a lab for review under a microscope. If abnormal cells are found, the Pap smear will be repeated and then, if abnormalities persist, a treatment plan activated. Not all abnormal readings indicate pre-cancerous cells.
For more information about HPV and Pap smears, talk to your doctor or specialist -- if you need help finding a doctor who is comfortable with lesbian health issues, ask friends for referrals, or contact resources such as Whitman-Walker Clinic. To find out more about Pap smears and HPV, and lesbian health issues, check out the following resources: